Provider Demographics
NPI:1306241567
Name:GEBHARDT, CAROL LOUISE (PHARMD)
Entity type:Individual
Prefix:DR
First Name:CAROL
Middle Name:LOUISE
Last Name:GEBHARDT
Suffix:
Gender:F
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3375 E CARDINAL WAY
Mailing Address - Street 2:
Mailing Address - City:CHANDLER
Mailing Address - State:AZ
Mailing Address - Zip Code:85286-5721
Mailing Address - Country:US
Mailing Address - Phone:480-275-4514
Mailing Address - Fax:
Practice Address - Street 1:3375 E CARDINAL WAY
Practice Address - Street 2:
Practice Address - City:CHANDLER
Practice Address - State:AZ
Practice Address - Zip Code:85286-5721
Practice Address - Country:US
Practice Address - Phone:480-275-4514
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-10-30
Last Update Date:2014-10-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZS014536183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist